Life in the grey Zone

Neonatal care has advanced so far that babies born as early as 21 weeks have survived. But is this type of care always the right thing to do?

- Sophie McBain

ALICE SMITH WAS FIVE MONTHS PREGNANT when she noticed some discharge one evening, and something felt off. She did an online yoga class and went to bed early, but the next day she felt worried enough to phone the maternity triage line. The midwives invited her in for a checkup at Homerton hospital, near her home in east London. Smith emailed her boss to explain she'd be offline for a few hours and then headed to hospital.

Until then, her pregnancy had progressed smoothly. She was 37 years old, healthy and expecting twins: a boy and a girl. A routine ultrasound a few weeks earlier had suggested all was well. Smith and her husband, Jim Clack, had already decided to name their daughter Peggy. For their son they had drawn up a shortlist of names.

In the waiting room at Homerton, Smith began to feel an ache in her lower back. When the registrar examined her, she told Smith that she was in labour and already 3cm dilated. The average pregnancy is about 40 weeks long, but Smith was just 23 weeks and four days pregnant. If the babies died, which was the most likely outcome, their deaths would be classified as a miscarriage rather than stillbirths.

Twenty-three weeks is on the cusp of viability. Every hour that the twins' birth could be delayed would improve their chances. The doctors gave Smith steroids, to strengthen the babies' lungs, and magnesium, which aids brain development. Smith phoned Clack, who rushed to the hospital.